A Multifaceted Approach to Diabetes Education

LUCY SCHULTZE

A Multifaceted Approach to Diabetes Education
Spreading the word about how to combat an American epidemic calls for methods as diverse as the nation itself.

In the case of diabetes, national health promotion efforts are targeting not only the broad U.S. population but also its most at-risk ethnic minorities, each with its own nuances of culture, language and community life.

It takes an insider’s knowledge to understand what messages will be most meaningful to people in key populations — Hispanic/Latino, Asian and Pacific Islander, African American and American Indian/Alaskan Native — as well as the plethora of subgroups within each one.

That’s why minority outreach is a key focus for the American Diabetes Association, which offers tailored programs of educational materials, community events and advocacy for people in groups disproportionately affected by diabetes.

It’s an effort Ann Albright, PhD, RD, feels passionately about. As director of diabetes translation for the Centers for Disease Control and Prevention (CDC) in Atlanta, she works closely with six national organizations that have direct access to high-risk ethnic groups and can craft education messages that fit within the way each culture lives and thinks.

That partnership is under the umbrella of the National Diabetes Education Program, established in 1997 to boost collaboration and improve collective efforts. It’s led by the CDC and National Institutes of Health, along with 200 partner organizations including the ADA.

Albright is currently serving as ADA’s president for healthcare and education.

What’s the thrust of ADA’s minority outreach programs today?


The thrust of ADA’s programs is to reach people in ways that are meaningful to them through different tools and outreach events.

It’s important to note that although we describe populations using broad terms, there are many sub-groups among these populations. There are many different Asian and Pacific Islander populations, just as there are many subsets of Hispanics, such as Mexicans and Puerto Ricans. Those are important distinctions to make when you’re talking about tools and culturally appropriate materials — things people can really relate to and that are meaningful to them.

In what ways is the ADA able to focus on specific groups?


The ADA has a small staff team and many volunteers that focus on these efforts and work to make sure the projects and tools are developed with input from people whom they’re targeting. So, for example, the program for Latinos, ‘Por tu Familia,’ was developed with tremendous input from Latinos.

They’re continually looking at what tools and programs are needed to fill needs and do work at trying to evaluate the impact of these programs. For example, there is a community-based effort called ‘Feria de Salud.’ It’s an outdoor community event intended to reach large numbers of Latinos, targeted in areas where there is a large Latino population. There is a lot of emphasis on nutrition in this campaign, so we’re trying to make sure they have books, materials, recipes, tip sheets and a lot of different kinds of things available through this effort.

The ADA is also an active participant in the CDC- and NIH-sponsored National Diabetes Education Program (NDEP). The NDEP has several work groups that develop materials and tools for a number of groups, especially high-risk ethnic populations. This is a great example of a partnership that helps increase reach and expand the use of limited resources.

How is ADA working among African Americans?


‘Project Power’ is a faith-based program targeting the African-American community primarily through work going on in the churches. Various educational workshops are being facilitated through Project Power, like Diabetes Day where the pastor or someone else devotes time to talk to members about the seriousness of diabetes. Another program is ‘Train Up a Child’ which is directed at trying to take a family approach to healthy lifestyles with regard to diabetes.

What about among Native Americans?


A significant effort the ADA has been focusing on has been an advocacy tool, because there is particular federal funding for American Indians. There is an authorization for moneys through Congress that has to be advocated for on a regular basis, and those moneys are primarily directed to the Indian Health Service for diabetes care and education, as well as, some effort directed at preventing type 2 diabetes.

The ADA’s program for the Native-American population is called ‘Awakening the Spirit.’ It provides culturally appropriate materials, with a lot of emphasis on nutrition and physical activity.

It also focuses on youth, trying to be sure youth don’t have the same outcomes as older generations. The population that’s hardest hit with type 2 diabetes among youth are American Indian children. The CDC reports that among children up to 9 years of age, type 2 diabetes is virtually nonexistent. Among those age 10 to 19, type 1 is still the most predominant — except in the American Indian youth, where type 2 diabetes is more common.

What do outreach efforts look like in that cultural context?


In American Indian culture, storytelling is a major way that both history and traditions are conveyed, and it’s also a very important way to convey health information. So along with our colleagues in the Indian Health Service, the CDC Diabetes Division worked with a Native American storyteller to develop the ‘Eagle Books,’ which talk about healthy behaviors and what Indian culture was like when diabetes wasn’t so prevalent there, and how to try to change that.

How long has ADA been delivering tailored messages in this way?


It’s been quite a long time, but what refreshes them is the new information that becomes available as these campaigns are examined and evaluated. You try to reinforce many of the same messages, but you need to be refreshing them and adding new materials. What we’re doing today is actually adding primary prevention as a focus. We’re trying to prevent the onset of type 2 diabetes in addition to offering programs directed to people who already have the disease.

What do local healthcare providers need to know about this effort?


They need to be aware of these materials and use them. We try to provide copies of materials as inexpensively as possible. That’s probably the biggest frustration: More people need to know where to go to get them and to use them with their patients.

Clearly handing somebody a piece of paper or a brochure is not a substitution for diabetes self-maintenance training or other services that are necessary for good diabetes management and prevention. But these materials can reinforce your message and when you use them with your patients or make them available in your offices, they can serve as a reminder to people.

To order or download materials, visit www.diabetes.org or www.ndep.nih.gov.